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Yogendra

Yogendra

Yogendra from India -- 24 years on various meds. Now on Desvenflaxine 50 mg Exteded Release

I am from Delhi, India and was put on such drugs around 24 years back. Now I am 38 years. I have gone through worst experiences in my life. I had a brain stroke around 25 years ago that left my left half of body weakened and paralyzed. I some how recovered mostly from it later on. But have been on psych. drugs for last 24 years ON and OFF. Years back I was on around 10 tabs per day. And many times I stopped medicines cold turkey too but had to come back again when symptoms striked again with full force.

I wish to come off from the meds. Currently for the last 6 months I have been on 50 mg desvenlaflaxine EXTENDED RELEASE tablet daily. I heard that extended release tablet should not be cut into pieces. I am in dire need of an advice how to wean off from medicines and live freely and calmly.

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Carmie

Carmie

Welcome to SA. I’m sorry you’ve been on so many medications, and the pain they’ve caused you. It was good too hear though that you’ve almost recovered from your stroke that you had years ago.

Could you first please put your drug history in your signature. Just go to the Read This First section and to the thread entitled “Please Put Your Withdrawal History In Your Signature.” It will tell you what to do there.

In the last two years have you been on any other medications?

When did you last cold turkey a medication?

Are you on any other medications or supplements, other than the desvenlaflaxine extended release now?

Current symptoms --- Impatient, anxious, anger but i guess they are bearable. I need to taper off this desvenlaflaxine ER film-coated 50 mg. But in market there is no lower dosage of it. And as it if film coated, I dont think crushing or cutting or making liquid is any good idea. Will talk to doctor about switching over. You guys if have any idea. Please help me. I am from India. I could not make myself dependent on pill for ever.

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ChessieCat

ChessieCat

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug. Why taper by 10% of my dosage?

I am also taking Pristiq and I get my tablets compounded. I have managed to get down to 2.75mg using this method. When I got to 10mg I started taking my dose twice a day, taking the larger portion in the morning and the smaller amount at night, to try and eliminate/lessen interdose withdrawal.

In some countries 25mg tablets are available, but not here in Australia, so I have been using capsules since reducing from 50mg. When I was taking 50mg+ doses I would take a 50mg tablet and make up the rest with capsules.

I got 40mg/30mg/20mg/10mg capsules made as well as 0.5mg, 1mg, 2mg and 5 mg so that I could make up the doses I need/ed. I've recently been getting 0.25mg doses and will soon be getting 0.125mg doses. See this post for my tapering schedule

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Yogendra

Yogendra

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug. Why taper by 10% of my dosage?

I am also taking Pristiq and I get my tablets compounded. I have managed to get down to 2.75mg using this method. When I got to 10mg I started taking my dose twice a day, taking the larger portion in the morning and the smaller amount at night, to try and eliminate/lessen interdose withdrawal.

In some countries 25mg tablets are available, but not here in Australia, so I have been using capsules since reducing from 50mg. When I was taking 50mg+ doses I would take a 50mg tablet and make up the rest with capsules.

I got 40mg/30mg/20mg/10mg capsules made as well as 0.5mg, 1mg, 2mg and 5 mg so that I could make up the doses I need/ed. I've recently been getting 0.25mg doses and will soon be getting 0.125mg doses. See this post for my tapering schedule

Some people change over to Effexor (venlafaxine) to taper. There is information about this in the above link.

Thanks CC for going through my case and recommending the way ahead. I have read many of your posts those were really inspiring. You are doing a very good work. It is only due to the people like you that we newbies come and get in touch with SA.

Here problem is that compounding pharmacies are not available. 25 mg ER version is also not available. Now I am in dilemma what to do. Nexvenla OD (desvenlaflaxine ER) here are only in tablet and film coated form. In India the situation is worse here nobody knows how exactly to taper off. Doctors know what to prescribe but when it come to withdrawal they are least bothered and unaware of.

I take stress of very small things also which happens in daily life. I want to cry. I want to leave everything and roam in nature wander freely but it is not possible as I am married and have one son 6 years and my wife is pregnant too. Don't know what has happened to me. I want to withdraw from this medicine at any cost. Help !!

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ChessieCat

ChessieCat

How can I taper down gradually especially when my med is extended release and film coated. And compounding pharmacies are not available in India I guess. I can buy pill cutters and weighing balance for milligrams. But my question is Can I cut / Crush these extended release film coated pillls?

You could try using a nail file (a metal one would be better than an emery board/sandpaper type) and file off some of the edge of a tablet and weigh it. At least then you will keep the tablet "whole" so would still retain most of the extended release character of the tablet. Please read the following which explains how Pristiq tablets are made:

On 7/17/2011 at 2:52 AM, Altostrata said:

Pristiq's extended-release formulation

According to this paper, the extended-release formulation releases desvenlafaxine over 24 hours. The mean half-life of desvenlafaxine, without the extended-release formulation, is around 11 hours. The extended-release formulation is a monolithic matrix -- it's in the glue that holds the tablet together, not in the coating.

Rather than a timed-release coating, the coating on the Pristiq tablet is only protective. The extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together. This is called a monolithic matrix tablet.

If the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability. A Pristiq fragment becomes desvenlafaxine, with an 11-hour half life.

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Yogendra

Yogendra

You could try using a nail file (a metal one would be better than an emery board/sandpaper type) and file off some of the edge of a tablet and weigh it. At least then you will keep the tablet "whole" so would still retain most of the extended release character of the tablet. Please read the following which explains how Pristiq tablets are made:

Hi,

The salt is same but it may not be a matrix type as mentioned in your quote. Mine is Nexvenla (desvenlaflaxine ER) OD 50 mg. The cover says it is film coated.

"We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds.

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Yogendra

Yogendra

For people who can't get their Pristiq tablets compounded, or can't afford the additional cost this might work:

You could try using a nail file (a metal one would be better than an emery board/sandpaper type) and file off some of the edge of a tablet and weigh it. At least then you will keep the tablet "whole" so would still retain most of the extended release character of the tablet. Please read the following which explains how Pristiq tablets are made:

Hi again,

I am on desvenlaflaxine ER 50 mg daily. Now I am thinking of switching to desvenlaflaxine ER 12.5 mg morning and venlaflaxine ER 75 mg at Night. Would it be a right approach ?

Then I shall gradually taper to only venlaflaxine ER 75 mg as this comes in capsules and it is easier to count/weigh beads in capsules.

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Yogendra

Yogendra

I've moved the post you made in the Tips for Tapering Pristiq topic and added it to your Introduction topic.

Your Introduction topic is the correct place to ask questions about your own situation. This keeps your history in one place.

I just want to make clear what you are thinking of doing.

You are thinking of taking desvenlafaxine plus venlafaxine to cross over to all venlafaxine?

I don't think we have had any members do this because it is difficult to get a 12.5mg dose from a 50mg desvenlafaxine tablet.

I will ask the other mods for their assistance.

Hello CC,

Yes you are right I wish to finally switch over from desvenlaflaxine ER to venlaflaxine ER as tapering the later one may be easier at it comes in capsules. It's because here in India we have only 1 or 2 compounding pharmacies and those too are not into compounding desvenlaflaxine ER. Hence this step.

Here I searched many pharmacies and found that one / two companies make 25 mg ER Desvenlaflaxine too so I bought yesterday 10 taps of 25 mgs. And it was mentioned on them that they are UNCOATED ones. So I guess extended properties of it comes from matrix only. I ordered a pill cutter too yesterday from Amazon so that I cud cut them into half 12.5 mg doses retaining Extended Release properties ( though I am not sure but I will do this and observe for a while).

Yesterday I also got my doctor prescribed them i.e. 25 mg ER desvenla. and 75 mg ER venla. But he warned me that the withdrawal from venla may be difficult one owing to short-life but I am ready to take that risk as at least then I cud taper in a more controlled way by bead-counting/weighing method. And when doses will be quite low then I wud switch over to immediate release version of venla. Making liquid form and taking twice / thrice a day if everything goes OK. I am afraid but I have no other option either.

I thank SA and people here. Before that I didn't even kNow that such thing as such forum exists or withdrawal from ADs are reality. I suffered a lot for the past around 24 years.

Better late than never. I will wait over to the said regime in a day or two. Will post the updates.

Thanks CC.

One more thing do we have some whatsapp group for us? If yes please tell me, I will share my contact info.

The tiny beads inside an Effexor XR capsule are extended-release, not immediate-release.

Thanks Alto,

Yes Here Desvenla. ER could not be compounded. For few weeks I may be on both Desvenla. ER and Venla. ER. Then gradually I will switch over to only Venla. ER. Will keep posting the updates. Let's see how it works.

I found enteric coated empty capsules on Amazon. Could we grind up the Pratique in powder form, weigh it according to tapering schedule and put that in the enteric coated capsules. Will it work similar to extended release version ? Any idea?

I have still not yet started switching over from Desvenlalaxine ER to venlaflaxine ER as I am very afraid and worried of any reaction and withdrawal symptoms. Guide please.

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ChessieCat

ChessieCat

Crushing Pristiq into a powder will make the drug immediate release. Compounding pharmacists add a slow release formula to the ground uptablets:

On 3/23/2016 at 10:50 AM, Fresh said:

About the "slow-release additive" (necessary for pristiq and some other meds.):

""We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds.

PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "

What are they?

Enteric coated capsules are capsules that have an acid resistant coating to prevent them from dissolving when they pass through the stomach. The capsules are activated only when they pass through an alkaline environment -- that is with a pH factor of 5.5 or higher - which is usually when they reach the small intestine.

Benefits

Enteric-coated capsules do not dissolve in the mouth and therefore are perfect for formulations that need not to be activated by acid exposure. The coating prevents the capsule from dissolving while in the mouth and oesophagus areas.

Many drugs can cause irritation to the stomach if released there; with enteric-coated capsules, the formulation will pass through the stomach without irritating the stomach lining.

The enteric-coating also prevents any enzyme present in the capsule from dissolving in the acid environment of the stomach area.

This enteric coated capsule typically takes an hour or two to dissolve, making it ideal for time- sensitive medications.

The tiny beads inside an Effexor XR capsule are extended-release, not immediate-release.

Dear Alto,

One question. Can Pratique 50 ER tablets be cut and weighed using a sensitive balance. Can this be done for tapering? I read that if the are crushed in powder they lose their extended release property. Rite?

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Altostrata

Altostrata

It will take 4 days or so for the drug switch to fully register. Or, you may be lucky and feel no difference at all. Tapering Effexor XR by removing the tiny balls will be a lot easier than cutting and weighing Pristiq tablets.

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Yogendra

Yogendra

It will take 4 days or so for the drug switch to fully register. Or, you may be lucky and feel no difference at all. Tapering Effexor XR by removing the tiny balls will be a lot easier than cutting and weighing Pristiq tablets.

Dear Alto,

I wud like to ask that can the pristique tablets be cut and crushed without losing ER property?

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delsol

delsol

I just want to respond to say good luck, and amidst the sea of many posts on here, the fact that yours says "24 years" is what made me click. It's been 27 years for me. I think those of us who have been on these drugs for over 20 years are probably more common than we realize. I sometimes feel shame and then remember that if it was easy to kick these drugs, I would have been able to do it 20 years ago! Wishing you peace and an occasional moment of wellness during this challenging time.